- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66,721.80 / $66,721.80 / $97,641.66
| Facility | | $66,721.80 | $66,721.80 | $97,641.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66,721.80 / $97,641.66 / $109,846.87
| Professional | | $66,721.80 | $97,641.66 | $109,846.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,273.44 / $43,273.44 / $43,273.44
| Facility | | $43,273.44 | $43,273.44 | $43,273.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43,273.44 / $43,273.44 / $43,273.44
| Professional | | $43,273.44 | $43,273.44 | $43,273.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,824.55 / $69,162.84 / $69,162.84
| Facility | | $56,824.55 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,162.84 / $69,162.84 / $69,162.84
| Professional | | $69,162.84 | $69,162.84 | $69,162.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,142.09 / $56,824.55 / $65,476.58
| Professional | | $51,142.09 | $56,824.55 | $65,476.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,416.37 / $67,806.71 / $86,467.79
| Professional | | $64,416.37 | $67,806.71 | $86,467.79 |